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Imaging approaches in risk stratification of patients with coronary artery disease: a narrative review

Gloria Santangelo1, Elisa Gherbesi1, Luca Donisi1,2

  • 1Department of Cardio-Thoracic-Vascular Diseases, IRCCS Foundation Ca' Granda Hospital Maggiore Polyclinic, Milan, Italy.

Archives of Medical Science : AMS
|April 7, 2025
PubMed

Insights

Coronary artery disease (CAD) risk is better assessed by plaque composition than ischemia severity. Advanced imaging can personalize treatment for patients with coronary artery disease.

Area of Science:

  • Cardiovascular Medicine
  • Medical Imaging
  • Interventional Cardiology

Background:

  • Coronary artery disease (CAD) is a leading global cause of death.
  • Accurate risk stratification in CAD patients relies on lumen stenosis, plaque volume, and composition.
  • Non-obstructive plaques with high-risk features frequently cause myocardial infarctions, highlighting plaque composition's prognostic value.

Purpose of the Study:

  • To review imaging methodologies for differentiating ischemia from plaque burden in clinical practice.
  • To explore the role of plaque composition as an independent predictor of cardiac outcomes.
  • To discuss the potential of new diagnostic tools for personalized therapeutic approaches in CAD.

Main Methods:

  • Narrative review of existing literature.
  • Discussion of current imaging techniques for assessing coronary artery disease.
  • Analysis of the relationship between ischemia, plaque burden, and clinical outcomes.

Main Results:

  • Plaque composition offers independent prognostic information for cardiac outcomes.
  • Assessing the degree of ischemia as a surrogate for plaque burden remains controversial.
  • Advanced imaging can potentially differentiate ischemia from plaque burden more effectively.

Conclusions:

  • Plaque characterization is crucial for prognostic risk stratification in coronary artery disease.
  • Imaging modalities capable of evaluating atheromatous coronary artery extent can guide personalized therapy.
  • Further development of diagnostic tools is needed to optimize patient management in CAD.

Keywords:
atherosclerotic burdencoronary artery diseaseischemiamultimodality imagingmyocardialplaque

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